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Asbestos Related Lung disease

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Asbestos exposed patients must stop smoking if they do not wish to reduce risks of cancer. In the UK, individuals diagnosed with asbestos-related lung diseases, such as asbestosis, mesothelioma, or lung cancer, may be eligible for compensation through several avenues

About

Asbestos is a collection of naturally occurring fibrous silicates with remarkable insulating properties
Asbestos fibres are strong, heat and chemical resistant and do not dissolve in water or evaporate
Boiler making to lag pipes, shipbuilding, construction industry, heat resistant paints and brake pads etc
Importation of blue/brown asbestos has been banned in the UK since 1985. White asbestos in 1999.
Asbestos is not considered harmful when in large pieces and undamaged
Damaged asbestos can release smaller fibres that can be breathed in or swallowed

Types of Asbestos

Serpentine: Chrysolite - White is the most common and least fibrogenic
Amphibole: Crocidolite (blue), Amosite (Brown): More hazardous
All forms of asbestos fibres are hazardous as they can induce cancer following inhalation exposure, but amphibole forms of asbestos (including blue and brown) are more hazardous to health than chrysotile (white).

Clinical Manifestations of Asbestos exposure(most take decades to present)

Type of Disease	Clinical Features	Diagnostic Tests	Management
Asbestosis	A sign of heavy asbestos exposure. Usually mild and takes 20-30 years to occur. Progressive dyspnoea, dry cough, bilateral inspiratory crackles, clubbing of fingers. Increased risk of lung cancer.	Chest X-ray (bilateral pleural plaques), High-Resolution CT (HRCT) scan showing fibrosis, Pulmonary function tests (restrictive pattern), Lung biopsy (if needed).	Supportive care (oxygen therapy), Smoking cessation, Vaccinations (influenza, pneumococcus), Pulmonary rehabilitation, Surveillance for lung cancer and mesothelioma.
Pleural Plaques	Generally asymptomatic and are markers of exposure, seen on imaging; may cause chest pain in some cases.	Chest X-ray (calcified pleural plaques), HRCT scan for better visualization.	No specific treatment needed, Patient education, Smoking cessation, Surveillance for other asbestos-related diseases.
Pleural Effusion	Dyspnoea, pleuritic chest pain, decreased breath sounds on the affected side.	Chest X-ray (blunting of costophrenic angle), Ultrasound or CT scan for further evaluation, Thoracentesis (to analyze pleural fluid).	Treatment of underlying cause, Thoracentesis (to relieve symptoms), Monitoring for recurrence or progression.
Diffuse Pleural Thickening	Progressive dyspnoea, chest pain, restrictive lung disease.	Chest X-ray (diffuse pleural thickening), HRCT scan, PFTs showing restrictive pattern.	Supportive care, Smoking cessation, Pulmonary rehabilitation, Surveillance for progression.
Mesothelioma	A progressive and aggressive tumour that can encase the lung causing chest pain, weight loss, fatigue, dyspnoea, pleural effusion, often with a long latency period from exposure to symptom onset.	Chest X-ray, CT scan, PET scan, Biopsy (definitive diagnosis), Pleural fluid cytology. Tumour can grow along needle tracks.	Multimodal therapy (surgery, chaemotherapy, radiation), Palliative care for advanced stages, Outcomes poor. Clinical trials for novel therapies.
Lung Cancer	More commonly adenocarcinoma but also squamous cell carcinoma are associated with asbestos exposure. Smoking is additive. Cough, haemoptysis, weight loss, chest pain, dyspnoea, often associated with a history of smoking and asbestos exposure.	Chest X-ray, CT scan, PET scan, Bronchoscopy with biopsy, Sputum cytology.	Depends on stage: Surgery, chaemotherapy, radiation therapy, Targeted therapies, Smoking cessation.

Pleural plaques - resemble candle wax dripping

Mesothelioma encasing lung

Investigations

CXR - pleural changes. Fibrosis. The effusion may suggest pleura disease
Pulmonary function tests identify a restrictive defect
HRCT - can show parenchymal and pleural disease
Bronchoscopy to look for tumour s

Management

As above.

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